Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a surgical technique in which procedures are performed with an endoscope passed through a natural orifice, such as the mouth, nose, urethra, vagina, or anus, for instance. An endoscope can also be passed though the umbilicus or a single incision, also referred to as Single Port Access (SPA), such as by using a trocar, in some instances. The endoscope can then be passed through an internal incision, such as an incision in the stomach, vagina, bladder, or colon, for instance. By performing NOTES procedures, external incisions or scars can be limited or eliminated altogether.